1

TENS DEVICE DESIGN FOR STIMULATION OF THE

ACUPUNCTURE POINTS

A THESIS SUBMITTED TO

GRADUAT SCHOLL OF APPLIED SCIENCES

OF

NEAR EAST UNIVERSITY

By

RABİA UYSAL

In Partial Fulfillment of the Requirements for

the Degree of Master of Science

in

Biomedical Engineering

NICOSIA, 2018

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ii

TENS DEVICE DESIGN FOR STIMULATION OF

THE ACUPUNCTURE POINTS

A THESIS SUBMITTED TO

GRADUAT SCHOLL OF APPLIED SCIENCES

OF

NEAR EAST UNIVERSITY

By

RABİA UYSAL

In Partial Fulfillment of the Requirements for

the Degree of Master of Science

in

Biomedical Engineering

NICOSIA, 2018

iii

RabiaUYSAL: TENS DEVICE DESIGN FOR STIMULATION OF THE

ACUPUNCTURE POINTS

Approval of Director of Graduate School of

Applied Sciences

Prof.Dr. Nadire CAVUŞ

We certify this thesis is a satisfactory for the award of the degree of Masters of

Science in Biomedical Engineering

Examining Committee in Charge:

Assist.Prof.Dr.Elbrus IMANOV Committee Chairman, Department of

Computer Engineering, NEU

Assit.Prof.Dr.Sertan KAYMAK Supervisor, Department of Electric

Electronic Engineering, NEU

Prof.Dr.İnan GÜLER Co-supervisor, Department of Electric

Electronic Engineering, NEU

Assist.Prof.Dr.Umar ÖZGÜNALP Department of Electric Electronic

Engineering, NEU

iv

I hereby declare that all information in this document has been obtained and presented in

accordance with academic rules and ethical conduct. I also declare that, as required by

these rules and conduct, I have fully cited and referenced all material and results that are

not original to this work.

Name, Last name:Rabia UYSAL

Signature:

Date:

v

ACKNOWLEDGEMENTS

First and foremost I would like to thank my supervisor Dr.Sertan Kaymak and co-

supervisior Prof.Dr.İnan Güler , who deserves special thanks for his constant motivation

throughout this thesis. I am also thankful for the contributions and comments the teaching

staff of the Department of Biomedical Engineering.

This research was generously supported by the Department of Biomedical Engineering of

the Near East University. I am grateful to all supporters.

Finally, I would like to thank my family who support me by not to lose the trust and also I

thank all my friends who always support me.

vi

To my family and friends…

vii

ABSTRACT

In this project, firstly physical therapy methods that can be applied with electric energy and

the effects of these methods on the body are examined; electrotherapy has been focused on

the widely used TENS device. In particular, a study was conducted to apply TENS

treatment to acupuncture points. For the practical part of the project, the TENS device was

designed to be applied to the acupuncture points. The innovations introduced by the

designed device are different from the similar ones; easy-to-use, low-cost, varied options

for treatment programs suitable for patient use, integrations and back-end for

programming. Device; frequency, current power, impulse width as a set of three options

are available.

Acupuncture is a scientific treatment method applied by sinking the needle into certain

points in the body. According to this treatment method, there is a network of energy that

surrounds the entire surface of the body. There are central dots that reduce, increase, divert,

direct, or even point to a certain point. These points are known as 'motion awakening' or

'reflex stimulant'. The aim is to apply electrotherapy to these points by stimulating these

points with the aid of the designed TENS device. Thus, it was aimed that the patients

would receive an alternative treatment using more drugs.

Keywords: physical therapy; electrotherapy; TENS;acapuncture; acapuncture modulation

viii

ÖZET

Bu projede, öncelikle elektrik enerjisiyle uygulanabilen fizik tedavi yöntemleri ve

yöntemlerin vücut üzerindeki etkileri incelenmiş; elektroterapide yaygın olarak kullanılan

TENS cihazı üzerinde durulmuştur. Özellikle TENS tedavisinin akapunktur noktalarına

uygulanması için bir çalışma yapılmıştır. Projenin pratik kısmı için ise akapunktur

noktalarına uygulanmak üzere TENS cihazı tasarımı yapılmıştır. Tasarlanan cihazın

benzerlerinden farklı olarak ortaya koyulan yenilikleri; kullanımı kolay, maliyeti düşük,

hastaların kullanımına uygun tedavi programları için değişebilen opsiyonlar, entegreler ve

programlama için ardunio kullanılmıştır. Cihaz; frekans, akım gücü, impuls genişliği ayarı

olarak üç farklı opsiyon sunmaktadır.

Akupunktur, vücutta bulunan belirli noktalara iğne batırılarak uygulanan bilimsel bir

tedavi yöntemidir. Bu tedavi yöntemine göre vücudun bütün yüzeyini saran bir enerji ağı

vardır. Bu enerjiyi azaltan, arttıran, saptıran, yönelten hatta belirli bir noktaya doğru

yönelten merkez noktaları vardır. Bu noktalar tıpta ‘hareket uyandırıcısı’ ya da ‘refleks

uyandırıcısı’ olarak bilinir. Amaç, bu noktaları tasarlanan TENS cihazı yardımı ile

uyararak hastalara elektroterapi uygulamaktır. Böylece hastaların daha ilaç kullanarak

alternatif bir tedavi görmesi amaçlanmıştır.

Anahtar Kelimeler: fizik tedavi; elektroterapi; TENS; akapunktur; akapunktur modulation

ix

TABLE OF CONTENTS

ACKNOWLEDGEMENTS ................................................................................................ v

ABSTRACT ....................................................................................................................... vii

ÖZET ................................................................................................................................. viii

TABLE OF CONTENTS ................................................................................................... ix

LIST OF TABLE ................................................................................................................ xi

LIST OF FIGURE ............................................................................................................. xii

CHAPTER 1: INTRODUCTION

1.1Thesis Problem ................................................................................................................ 1

1.2 Aim of Thesis .................................................................................................................. 2

1.3 Overview of the Thesis .................................................................................................... 3

CHAPTER 2: LITERATURE REVIEW

2.1 Physical Therapy and Rehabilitation ............................................................................... 4

2.1.1 Physical Therapy Agents .......................................................................................... 4

2.1.1.1 Thermal Agents .................................................................................................. 4

2.1.1.2 Mechanical Agents ............................................................................................. 5

2.1.1.3 Electromagnetic Agents ..................................................................................... 5

2.2 Electrotherapy ................................................................................................................. 5

2.3 TENS ............................................................................................................................... 8

2.3.1 History of TENS ...................................................................................................... 8

2.3.2 TENS Device and Working Principle ...................................................................... 9

2.3.3 Types of Pain Used by TENS Devices ................................................................... 11

2.3.4 TENS Parameters .................................................................................................... 13

2.3.5 Types of TENS ....................................................................................................... 13

2.3.6 Application Techniques of TENS .......................................................................... 14

2.3.6.1 Conventional Mode .......................................................................................... 14

2.3.6.2 Acupuncture Mode ........................................................................................... 15

2.3.6.3 Brief Intense ..................................................................................................... 15

2.3.6.4 Burst Mode ....................................................................................................... 16

2.3.6.5 Modulated Mode .............................................................................................. 16

x

2.4 Acupuncture .................................................................................................................. 17

2.4.1 The History of Acupuncture ................................................................................... 17

2.4.2 The Effects of Acupuncture .................................................................................... 18

2.4.3 Acupuncture Application- How is it done? ............................................................ 19

2.4.4 Electro acupuncture ................................................................................................ 21

2.5 Overview Of The Existing Tens Devices/ Aplications .............................................. 24

CHAPTER 3: METHODOLOGY

3.1System Model ................................................................................................................. 26

3.2 Basic Circuit .................................................................................................................. 26

3.2.1 Power Source ......................................................................................................... 29

3.3 Signal Modelling ........................................................................................................... 26

3.4 Displaying Signal Parameters ........................................................................................ 30

CHAPTER 4: PERFORMANCE OF SYSTEM AND DISCUSSION OF RESULTS

4.1 Performance of System .................................................................................................. 31

4.2 Discussion of Results ................................................................................................... 32

CHAPTER 5: CONCLUSION

5.1 Conclusion ..................................................................................................................... 34

REFERENCES .................................................................................................................. 35

xi

LIST OF TABLE

Table 2.1:Physical therapy agents ....................................................................................... 5

Table 2.2: Parameter values of different TENS applications ............................................. 14

Tablo 2.5: Overview of the existing tens application ......................................................... 25

xii

LIST OF FIGURE

Figure 2.1: A simple model of electrotherapy ...................................................................... 6

Figure 2.2: Electrotherapy treatment on back and neck pain ............................................... 7

Figure 2.3:The electrode of transcutaneous electrical nerve stimulation of acupuncture

points ................................................................................................................................... 10

Figure 2.4: Applicaton of TENS ........................................................................................ 11

Figure 2.5: Placement diagram of tens electrodes .............................................................. 12

Figure 2.6: Conventional mode TENS signals ................................................................... 15

Figure 2.7: Acupuncture mode TENS signals .................................................................... 15

Figure 2.8: Brief intense TENS signals .............................................................................. 16

Figure 2.9: Burst mode TENS signals ................................................................................ 16

Figure 2.10: Modulated mode TENS signals ..................................................................... 16

Figure 2.11: Application of acupuncture ............................................................................ 20

Figure 2.12: Acupuncture points on the ear ....................................................................... 21

Figure 2.13: Applcations of electroacupuncture ................................................................ 22

Figure 2.14:Mechanism of action of acupuncture like TENS ............................................ 23

Figure 3.1: The block diagram of the device circuit .......................................................... 25

Figure 3.2: The design of the circuit .................................................................................. 27

Figure 3.3:The basic circuit of device ................................................................................ 28

Figure 3.4:The LCD screen of the device .......................................................................... 30

Figure 4.1: Square wave ..................................................................................................... 31

Figure 4.2: Square wave ..................................................................................................... 32

1

CHAPTER 1

INTRODUCTION

Physical therapy and rehabilitation is the science that helps to repair and repair physical

and functional damage in neuromuscular, musculoskeletal and cardiovascular systems.

This sciatica helps patients to recover physical and functional movements lost due to many

reasons such as injury, illness, trauma or old age, electric current, hot or cold applications,

exercises or various waves. Physiotherapists practice physical agents (hot-cold water,

pressure, sound) and techniques appropriate for the area to be treated.TENS is a simple,

noninvasive modality in physiotherapy that is commonly used to control both acute and

chronic pain arising from several conditions (Itoh et al., 2009).

1.1. Thesis Problem

The history of physiotherapy is based on the time of Hippocrates. In ancient times, too, the

patients; massage, hydrotherapy, and so on. However, the first professional physical

therapy was started in Europe in the 17th century. Massage and exercise techniques were

applied to the illness.

The first steps of Hacettepe University in Turkey in 1961 with the opening of Physical

Therapy and Rehabilitation physiotherapy profession High School was laid.

Physical therapy techniques, consisting of massage and exercise, have been developed day

by day and nowadays have become a medically proven treatment option.Physical therapy

and other health care fields are beginning to explore, in increasing depth, the proper

interpretation of tests and measures and the clinical changes that score improvements

represent (Haley et al.,2006).

2

1.2. Aim of Thesis

The most useful and effective method of electrotherapy, in which alternative forms of

electric current are used as a physical effect, is TENS (Transcutaneous Electrical Nerve

Stimulation). The simplest definition of TENS is stimulation of the electrical nerve with

the help of the skin tract. This method is completely safe and successfully applied on

thousands of patients. With the help of TENS therapy, nerves that stimulate the production

of analgesic substances in the brain and spinal cord are stimulated. Thus, in the treatment

of pain, the natural medals produced by the body itself are used. So with TENS therapy,

the patient either uses minimal or no medication. Thus, the body is at least affected by side

effects of drugs.

The handy features of TENS therapy are practical, side-effectless, battery operated, small

and comfortable portable devices. Of course, this therapy should be done with a doctor's

recommendation. Patients should apply their doctor's recommendations and proper

treatment plans.

Acupuncture is a treatment with the application of thin needles at certain points in the

body. It is an extremely effective treatment option especially in the treatment of pain.

TENS applied to the acupuncture points affects the C fibers with the electric current

supplied, it helps the secretion of endorphin hormone, and helps to relieve pain.

In this project, firstly physical treatment methods which can be applied with electricity

energy and the effects of methods on the body have been examined. TENS devices are

widely used in the treatment of electrotherapy. In particular, a study was conducted to

apply TENS treatment to acupuncture points. For the practical part of the project, the

TENS device was designed to be applied to the acupuncture points.

The innovations introduced by the designed device are different from the similar ones;

easy-to-use, low-cost, varied options for treatment programs suitable for patient use,

integrations and back-end for programming. Device; frequency, current power, impulse

width as a set of three options are available.

3

1.3. Overview of the Thesis

The present thesis is structured as the following:

Chapter one isan introduction of the presented thesis. In here, the physical therapy and

electrotherapy importance is presented, as well as the aims of the thesis.

Chapter two is overview ofthe relationship between physical therapy, TENS, and

acupuncture and their application.

Chapter three sows methodology of the proposed work in addition to the design and used

materials.

Chapter four is given the information of the performance of the system and the discussion

of the results.

Finally, chapter five shows the conclusion of the thesis.

4

CHAPTER 2

LITERATURE REVIEW

2.1. Physical Therapy and Rehabilitation

Physical therapy and rehabilitation is an important sub-science of medicine. It has begun to

be applied in various ways in history and has developed with the use of electricity.

Physical therapy and rehabilitation is a science that helps to repair and repair physical and

functional damage to neuromuscular, musculoskeletal and cardiovascular systems. Electric

current, cold or hot applications, regional exercises and various waves are used for

treatment. Therefore, the use of drugs by the patients is reduced, even in some patients the

drug is not used at all, so that the patient is not affected by the side effects of the drugs.

Devices use electrical current with devices (physical, laser, infrared, ultraviolet), heat

(ultrasound, shortwave, microwave diathermy), and therapeutic devices.

2.1.1. Physical Therapy Agents

Physical therapy agents consist of different types of energy and equipment applied to the

illness. These agents are; hot or cold applications, water, sound and currents.Physical

agents may serve as useful adjunctive modalities of pain relief or to enhance the

effectiveness of other elements in therapy geared toward resolution of movement

impairments and restoration of physical function (Allen, 2006).

Physical therapy agents; thermal, mechanical and electromagnetic.

2.1.1.1. Thermal Agents

The energy is transferred to the patient to reduce the elevation of the existing heat of the

tissues. Different agents cause heat exchange in different types of tissues.

5

2.1.1.2. Mechanical Agents

Mechanical agents are intended to change the pressure on the body. Apply mechanical

force to increase or decrease pressure on the body.

2.1.1.3. Electromagnetic Agents

They are applied in the form of energy, electromagnetic radiation or electric current. It

affects the frequency and intensity of the electromagnetic radiation. The electric current

depends on the characteristics of the current such as wave form, density, duration,

direction.

Table 2.1: Physical therapy agents (Slideplayer)

2.2. Electrotherapy

Electrotherapy is the use of electrical agents for diagnosis and treatment. The history is

quite old. Endorphins are substances that control the body's pain points and electrotherapy

helps to secrete these substances into the body.

6

Choosing the right device for the successful outcome of electrotherapy, and choosing the

appropriate and effective treatment is very important. The physical effect of the electric

current is utilized.Electrotherapy Explained is an excellent research-based exploration of

the major types of electrophysical agents used in clinical practice, particularly human and

also animal (Robertson, Low, Ward and Reed, 2006).

Figure2.1: A simple model of electrotherapy(Watson, 2002)

The most useful and effective method of electrotherapy using alternative forms of

electrical current as a physical effect is TENS. The simplest definition of TENS is

stimulation of the electrical nerve with the help of the skin tract.Transelectrical nerve

stimulation (TENS) is a form of electrotherapy and is thought to produce analgesia

according to the gate control theory (Brosseau et al,. 2003)

7

Figure 2.2:Electrotherapy treatment on back and neck pain (simpleposture)

Transcutaneous electrical nerve stimulation (TENS) is a noninvasive, self‐administered

technique to relieve pain (Johnson, 2007).

TENS therapy is administered through small, portable and generally pille-operated devices.

TENS devices are reliable.

During TENS, pulsed electrical currents are administered across the intact surface of the

skin to generate strong nonpainful TENS sensations or mild muscle twitching at the site of

pain(Johnson, 2007). The application performed by electric current induction of nerve

tissue near the surface of the skin with glued electrodes.

Acupuncture is a treatment with the application of fine needles at certain points in the body

and is an extremely effective treatment option, especially in the treatment of pain. In

traditional Chinese medicine the concepts of “meridian” and the vital energy “Qi” form

part of the theoretical basis for needling at specific acupuncture points (Vickers and

Zollman, 1999).

Acupuncture stimulates the central nervous system, helping to secrete natural chemicals

that affect the biological order of the body. Since no external chemicals are given to the

body, it is definitely a natural treatment and there are no side effects.

8

In patients in whom standard medical practice (pharmacological treatment) is ineffective

and who are not candidates for surgery (or who reject it), other pain management

procedures should be considered (Vas, Perea-Milla and Mendez, 2004).

According to this treatment method, there is a network of energy that surrounds the entire

surface of the body. There are central dots that reduce, increase, divert, direct, or even

point to a certain point. These points are known as 'motion awakening' or 'reflex stimulant'.

The aim is to apply electrotherapy to these points by stimulating these points with the aid

of the designed TENS device. In this project, a study was conducted to apply TENS

treatment especially to acupuncture points. Thus, it was aimed that the patients would

receive an alternative treatment using more drugs.

2.3. TENS

The expansion of TENS is Transcutaneous Electrical Nerve Stimulation. TENS evokes a

natural defense mechanism against pain in the patient's body. TENS is the most useful and

effective method of electrotherapy in which alternative forms of electric current are used as

physical effect. The simplest definition of TENS is stimulation of the electrical nerve with

the help of the skin tract. In conclusion, TENS is a noninvasive modality that is easy to

apply with relatively few contraindications (Sluka and Walsh, 2003).With the help of

TENS therapy, nerves that stimulate the production of analgesic substances in the brain

and spinal cord are stimulated. Thus, natural substances produced in the body are used in

the treatment of pain.

2.3.1. History of TENS

According to research by the Roman historian Sribonus, Egyptians used electric eel to

apply pain therapy. Then, the first electrical current was used to induce narcosis in the

patient in 1850,in America.

9

TENS devices, which produce short-term stimuli in direct current, were first used in 1919.

Wall and Sweet observed that chronic pain decreased shortly as a result of electrical

stimulation of the peripheral nerves via electrodes placed on the skin.

Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological method of

labour analgesia that has been used for over 30 years in European countries (Santana et al.,

2016).Since 1965, more and more electric current is being used to treat pain. TENS has

become a recognized treatment option and has continued its development up to day-to-day.

It helped patients reduce the use of pain medication. Among the preferred types of

treatments on this scale is the literature.

2.3.2. TENS Device and Working Principle

The application is performed by electric current induction of nerve tissue near the surface

of the skin with glued electrodes. The applied electric current is very low and very reliable.

Alerts are first delivered to the nerves under the skin and then to the brain via nerves. In

this way, the electric current in the brain changes the pain sensation, and the pain becomes

unrecognizable. TENS produces a significant decrease in pain during labour and postpones

the need for pharmacological analgesia for pain relief (Santana et al., 2016).

10

Figure 2.3:The electrode of transcutaneous electrical nerve stimulation of acupuncture

points (Cheing and Chan, 2009).

Tens signal helps reduce the pain and allows the secretion of the body's own secretory

endorphin. The electrodes are placed in the body depending on the tissue and the location

of the pain. It is generally placed around the area of pain or around this area.

It is very important to put the correct point on the electrodes. If the treatment is going to

continue at home, the doctor should find out where the patient electrodes will be placed.

TENS therapy can also be used to accelerate blood circulation.

Among the therapeutic applications of TENS are pain relief, temperature alteration, and

blood flow increase (Itoh et al., 2009).

11

Figure 2.4: Applicaton of TENS (Elsa)

2.3.3. Types of Pain Used by TENS Devices

• Headache (migraine)

• Movements and pain in protective organs (spine, joint and muscle pain)

• Rheumatic pain

• Pain in the nerves (trigeminus, ischialgi, hexenschuss,)

• Phantom paints

• Wound pain

• Itching for

• Cancer or metastatic pain

• Post-operative pain

• Pain in the region and neck

12

• Partial temporary paralysis

• Kidney diseases

• Arthritis

• Slimming

Figure 2.5: Placement diagram of tens electrodes (Tensproducts)

13

2.3.4. TENS Parameters

The TENS application has several models. These models vary according to the muscle and

nerve tissue to be applied. These models are; amplitude, wavelength, and frequency

parameters. The doctor follows a path according to the patient's complaint. It adjusts the

duration of the stimulation and the intensity of the current, which the patient can tolerate.

The parameters are adjusted according to the region where the application is to be

performed and the degree of discomfort.

a) Amplitude

It refers to the magnitude of the applied current wave. In TENS applications it is generally

set to 0-80mA. The severity of the current depends on the patient's perception. But usually

small-amplitude waves are used.

b) Wavelength

The duration of the applied current value is indicated and an electric stimulation is usually

performed in 50-300 μs.

c) Frequency

It is the number of waves produced within one second at a frequency of 1-150 Hz.

2.3.5. Types of TENS

Clinical type tens device: Non-removable 220V city mains voltage. There are 4, 6, 8,

independent channel models.

Portable tens device: Portable 9V battery. Single-channel or two-channel models are

available.

14

2.3.6. Application Techniques of TENS

• Conventional or High Frequency

• Acupuncture or Low Frequency

• Brief Intense

• Burst Mode

• Modulated

Table 2.2:Parameter values of different TENS applications(Özdemir et al,. 2015)

2.3.6.1. Conventional Mode

It is a widely used mode. In this mode, low-intensity but high-frequency stimulation is

used. The values are adjusted according to the condition of the patient and do not disturb

the patient. Affects myelinated, afferent alpha and beta fibers.To selectively activate large

diameter non-noxious afferents to elicit segmental analgesia (Johnson, 2007).

15

Figure 2.6:Conventional mode TENS signals

2.3.6.2. Acupuncture Mode

A TENS application similar to acupuncture application is applied. High-intensity but low-

frequency stimulation is performed. High electrical current is applied so as not to disturb

the patient. The purpose in this mode is to influence small diameter C fibers. It also helps

in endorphin secretion in the body.To produce muscle twitches to activate small diameter

motor afferents to elicit extrasegmental analgesia (Johnson, 2007).

Figure 2.7: Acupuncture mode TENS signals

2.3.6.3. Brief Intense

In this treatment, TENS is stimulated with high frequency and high intensity current. In

this mode, the C fibers are activated. It is a difficult warning to apply to the patient.

To activate small diameter noxious afferents to elicit peripheral nerve blockade and

extrasegmental analgesia (Johnson, 2007).

16

Figure 2.8: Brief intense TENS signals

2.3.6.4. Burst Mode

Two waves are applied in different frequencies in this mode. Consecutive stimuli are

applied with high and low frequency.

Figure 2.9: Burst mode TENS signals

2.3.6.5. Modulated Mode

It is a mode applied to increase the tolerance of the patients to the treatment and tolerance.

Modulation is done by changing the parameters.

Figure 2.10: Modulated mode TENS signals

17

2.4.Acupuncture

Acupuncture is the stimulation of special points on the body, usually by the insertion of

fine needles (Vickers and Zollman, 1999). Acupuncture is a scientific treatment method

applied by sinking the needle into certain points in the body. According to this cure, there

is a network of energy surrounding the entire surface of the body. In the body there are

center points that reduce, increase, divert, direct or even direct this energy towards a

certain point. These points are known as 'motion awakening' or 'reflex stimulant'. The most

important use of this method, which is used in many areas, is pain treatment. Acupuncture

is a word that comes from a combination of two lambs (acus: needle, puncture: sink).

2.4.1. The History of Acupuncture

It is suggested that the written period of Chinese history is based on a very old time.

Acupuncture, implemented by the Chinese for the first time in 2000s BC, is being used by

the Western World for the last 50 years.

According to Chinese medicine, Chi energy in the body is circulated through the meridians

and channels with some special moves (Göksoy, 2010). Bian sharp-edged stones were used

instead of needles in this period. In the book titled "Analytical Words of Characters"

written in the period of Khans (BC.206-M.S.220), bian stones were used for treatment. In

time, bones and bamboo needles were used instead of bian stones. Nowadays it is used

gold, silver and steel needles.

After 1950, he began intensive studies on the scientific definition of acupuncture and

scientific theories. Dr. Paul Nogier introduced the basic principles of modern ear

acupuncture used today. According to Chinese medicine, Chi energy is carried in the body

by some special meridians and channels. In 1972, US President Richard Nixon and his

delegation made an official visit to China. During this visit, the Chinese doctors were

presenting the delegation "a surgical operation under acupuncture anesthesia". Later,

interest in acupuncture has increased; has begun to be applied all over the world.

18

The first acupuncture studies were made by Dr. Kayır Doy in Turkey. He studied

medicine in Russia and then studied acupuncture in China. In 1960, the first acupuncture

treatment center was opened in Istanbul.

2.4.2. The Effects of Acupuncture

Acupuncture stimulates the electrical signals in the body, helping to secrete immune

system cells and pain relieving chemicals. It provides pain and pain control by reducing

activity in the limbic system, which is associated with the brain's pain. The pituitary gland

is stimulated by the hypothalamus, which controls many mechanisms in the body. It affects

the secretion of neurotransmitters and neurohormones..

Acupuncture most likely produces its effects through activation of sensory receptors in the

skin, the muscle, or other innervated structures (Kalyon, 2007). The stimulation of the

afferent fibers activates the pain modulatory systems in a similar way as explained by the

gate-control mechanism and/or physical neuromatrix mechanisms (Kalyon, 2007).

i. Analgesic Effect

It is one of the most used effects. This effect is applied to specific points on the body in

head, waist, rheumatism and similar pain.

ii. Sedation Impact

In some patients EEGs taken during acupuncture treatment, changes in the brain waves of

patients were observed. This effect of acupuncture is used for the treatment of insomnia,

epilepsy and some psychological diseases.

19

iii. Hemostasis effect

The body is intended to come to an appropriate balance. It helps balance the body's

sympathetic, parasympathetic and endocrine systems. It has a regulatory effect in many

diseases, and helps to make the necessary repairs to ensure equilibrium.

iv. The Impact of the Immune System

It strengthens the immune system. Increases the body's resistance to disease. After

acupuncture treatment, the amount of leukocyte in the body was found to increase.

Due to this effect, in the case of any infection requiring antibiotic treatment, the duration of

antibiotic treatment of the patient is observed to decrease if treatment acupuncture

application is added. It has also been an effective treatment option for patients with

antibiotic resistance.

v. Psychological Impact

The levels of dopamine and serotonin in the brain are increased following acupuncture

therapy. This has led to an effective method of treating patients.

vi. Engine Repair Effect

Motor recovery is accelerated by acupuncture in the resulting paralysis.

2.4.3. Acupuncture Application- How is it done?

Acupuncture therapy can be considered as a method of regulating the inner energy of the

body. According to the understanding of this treatment method, there is a network of

energy that surrounds the entire surface of the body.

20

It is proposed that acupuncture produces its effects through regulating the nervous system,

thus aiding the activity of pain-killing biochemicals such as endorphins and immune

system cells at specific sites in the body (Moffet, 2006).

There are certain points that reduce, increase, deflect, direct, or even point to a certain

point of this energy. Acupuncture occurs with the application of fine needles at this point

in the body. Acupuncture is known to stimulate A delta fibres entering the dorsal horn of

the spinal cord (Vickers and Zollman,1999).

These mediate segmental inhibition of pain impulses carried in the slower, unmyelinated C

fibres and, through connections in the midbrain, enhance descending inhibition of C fibre

pain impulses at other levels of the spinal cord (Vickers and Zollman,1999).

Figure 2.11: Application of acupuncture (everydayhealth)

Depending on the condition of the patient, the specified point in the body is immersed in a

needle, heated with special rods called moksa, and sent by laser beam or electric current.

Thus, stimulation of these special points helps to improve certain chemical changes in the

body.

21

The patient's body can be applied to different locations such as head, face, nose, hand, foot,

ear.

Figure 2.12:Acupuncture points on the ear

For the needle method, very thin and disposable sterile needles made of steel, gold and

silver are used. The length of the needles varies according to the region to be used on the

body. The needle length varies from 0.5 to 8 cm on average.

The depth of penetration and direction of the needle also change according to the feature of

the point. Needle therapy is easy to use even for children and does not cause any pain or

pain except for a slight stinging sensation.

2.4.4. Electro acupuncture

Electroacupuncture is very similar to traditional methods and applies to the same region in

bodyduring treatment. Electroacupuncture (EA) stimulation, an application of electrical

current on acupuncture needles, is one of the most popular types of this traditional therapy

22

(Cabioğlu and Cetin, 2008). As in acupuncture, the needles are placed at certain points in

the body.

Then the needles are connected to device and produces current by means of small clips.

The parameters of these devices are very important for the patient. The frequency and

intensity of impression given for treatment should be adjustable.

Figure 2.13: Applcations of electroacupuncture(sevilakova)

The advantage of electric acupuncture is that the electric current induces a wider area. In

electro acupuncture, two injections are made in the same time and the electric current can

pass from one needle to another in the body.

Small devices are used to generate the electric current, to modulate the current, and to

connect the needles to the needles to send electric current. Electric charge is very low and

is set by the patient or acupuncturist. Both the voltage (intensity) and the frequency of the

electric charge can be adjusted to bury the healing effects.

23

Another similar treatment is TENS (Transcutaneous Electrical Nerve Stimulation), which

is an effective method of stimulating with electrodes that stick to the surface of the deep

rather than immersing the needles.

This technique, which can be advantageous for people who are at risk of needle

penetration, stimulates nerve and muscle groups at the same time.

Figure 2.14:Mechanism of action of acupuncture like TENS (Johnson,2007)

24

2.5. Overview Of The Existing Tens Devices/ Applications

When we look at the literature we see with a few similar designs. One of these designs is

named 'Physical Therapy Methods and Microcontroller Tens Design'. This design is a

master's thesis at Istanbul Technical University Institute of Science (Korürek and

Buran,2002). This study was based on the application of the modalities used in different

pain patterns to the patient with the aid of a microcontroller by showing the effect of TENS

on different mechanisms.

Another design is named 'Tens Device Design from Physical Therapy Methods'. This study

is a licensing project at Near East University Biomedical Engineering (Danacı et al,.2017).

In this project, the Tens design is made with integrated circuits and two different wave

modes are used.

Another design is named 'Microcontroller Controlled Tens Device Design'. This work was

included in the National Congress of Medical Technologies (Eroğlu et al,. 2015). In the

study, a PIC controlled circuit design was made for TENS application.

In our design, Tens application is applied directly to acupuncture points. Another

difference is that the third of the frequency, amplitude and wave width inversion options

can be adjusted within the desired range. The square wave we created is derived from 556

integrations. The parameter control is provided by potentiometers and the LCD display we

have added to the device is programmed with Ardunio for ease of use.

25

Tablo 2.5: Overview of the existing tens application

DEVICE NAME OF THE SYSTEM SYSTEM PARAMETERS SYSTEM CONTROL

MECHANISM

Korürek and Buran, 2002 Physical Therapy Methods

and Microcontroller Tens

Design

Mod A and Mod B include

different current

modulations with low and

medium frequencies.

Microcontroller

Danacı et al,. 2017 Tens Device Design from

Physical Therapy Methods

Two different

modulations are include and

two different waves are

generated.

Potentiometers

Özdemir et al,. 2015 Microcontroller Controlled

Tens Device Design

An adjustable square wave

signal is produced at

different frequencies and

amplitude.

Microcontroller

Ours Tens Device Design For

Stimulation Of The

Acupuncture Points

An adjustable square wave

signal is produced at

different frequencies, wave

width and amplitude.

Arduino

26

CHAPTER 3

DESIGN AND ELEMENTS OF CIRCUIT

3.1 System Model

In this project, firstly physical therapy methods that can be applied with electric energy and

the effects of these methods on the body are examined; electrotherapy has been focused on

the widely used TENS device. In particular, a study was conducted to apply TENS

treatment to acupuncture points. For the practical part of the project, the TENS device was

designed to be applied to the acupuncture points.

The purpose of the circuit designed in this study is to produce an adjustable square wave

signal at different amplitudes, at different frequencies. It is planned to transfer the

appropriate electrical currents to the patient with the help of the electrodes. The block

diagram of the circuit is shown below.

Figure 3.1:The block diagram of the device circuit

27

Figure 3.2:The design of the device circuit

Our aim is to produce an adjustable square wave of different amplitude and frequency, and

to stimulate the body with the help of electrodesin this work. System frequency, amplitude

and wave width can be controlled in this designed. They must be; Frequency:1-10 Hz,

Wave width:200-300µs, Amplitude: high.The parameter control is provided by

potentiometers. The square wave we created is derived from 556 integration.A square

wave form is required for stimulation of the patient's nerve muscles.A program written

with the help of arduino, than the analog signals displayed digital signals on an LCD

screen. The desing has consists of three parts.These; Power source, Basic circuit,

Triggering circuit (Arduıno and LCD parts).

Basic circuit

Arduino

LCD screen

28

3.2Basic Circuit

Figure 3.3:The basic circuit of the device

Basic circuit consisting of various elements. These are capacitors, resistors, 556 integrated

transformers and potentiometers.A square wave form is required to stimulate the nerve

muscles of the patient. Since 555 integrators have used two or three combinations in

previous projects, we chose only 556 integrations. We have done a innavation in this way

and we have reduced the amount of energy used by the circuit. The 556 integers used on

the square wave floor convert the DC voltage to square wave form. A square wave form

will be used to treat the painful area.This wave allows the currents to be delivered to the

patient with the help of electrodes.

The potentiometer is used for adjust the wave amplitudes, frequency adjustment and wave

width. The current was transferred to 3 different potentiometers. We obtained three

different outputs from three different potentiometers. We have defined these outputs as A0,

A1 and A3.Later, these three pots will be defined as an inputs to the arduino program.

When adjusting the signal parameters help of potentiometers, it is important to consider the

analgesic effect at the electrode junctions. Device parameters should be fixed in the

interval that the patient feels this effect. Because each patients treatment schedule will be

different.

556 entegre

entegre

potentiometers

potentiometers

Patient

Electrode

Trafo

Battery

connection

n

29

The voltage applied to the primary part of the transformer in the figure is raised by the

windings in the secondary section and the output is taken. And they are filtered by the help

of capacitors. Voltage setting and level setting with controlled by potentiometers.

3.2.1 Power Source

The power supply is the first part of the design. That feeds the system.The part of basic

circuit uses a nine volt dry and the part of arduino uses a five volt battery as the supply

source. Batteries use has become an economical solution for the circuit. We designed a DC

dry batteries circuit to isolate patients from mains electricity. Thus, the patients will not be

affected from the electricity and will not cause any damage.

The biggest advantage of working with the DC battery, that separates the patient from the

mains electricity (AC220V), and it has small dimensions and portable.

3.3 Signal Modeling

We have achieved signal modeling using to arduino. We have described three different

outputs for the arduino from the potentiometers on the basic circuit.We introduced the A0,

A1, A3 pots to the Arduino program. They are create a analog signal. The analog signal is

converted to digital form with the aid of the arduino and displayed digitally on the

screen.The wave width can be adjusted with the potentiometer on the hand.It is preferable

to produce square wave with integrated help that we use in our system. This wave allows

the currents to be delivered to the patient with the help of electrodes.

30

3.4 Displaying Signal Parameters

We have achieved show the system parameters using the LCD. Then we said that we

introduced three outputs of ardunio(A0, A1, A3 pots ). We made connections between the

LCD display and the arduino. The analog signal is converted to digital signal form and

displayed digitally on the LCD.The electric signal adjusted with the help of potentiometers

and as seen on the LCD screen. The connections we made between Ardunio and the LCD

screen are used to select pre-programmed parameters. The selected amplitude, frequency

and wave width are displayed on the LCD screen and are selected by potentiometers.

Figure 3.4:The LCD screen of the device

LCD screen

Patient

electord

e

Battery

Potentiometers

31

CHAPTER 4

PERFORMANCE OF SYSTEM AND DISCUSSION OF RESULTS

4.1 Performance of System

This project can be controlled frequency, amplitude and wave width. With the integrators

and potentiometers used, these three parameters can be controlled and the desired scale

change can be achieved. We connected the cycle designed for the project to the

oscilloscope and output of the device is showing.

Figure 4.1:Square wave

Output of the device signal can be seen in figüre 4.1. We are observing a wave at low

frequenc here.

32

When we arrive in Figure 4.2, while the amplitude is constant, frequency is increasing and

the change in the wave is observed.

Figure 4.2:Square wave

4.2 Discussion of Results

In this project, physical therapy methods that can be applied with electrical energy and the

effects of these methods on the body are examined. It is focused on TENS device which is

widely used in electrotherapy treatment. As a main goal, a study was carried out to apply

TENS treatment to acupuncture points. For the practical part of the project, the TENS

device is designed to be applied to the acupuncture points.

Useful features of this study are practical, side effect is very low, battery operated and low

cost. Of course, this treatment should be done with a doctor's recommendation. Patients

should apply their doctor's recommendations and treatment plans recommended by

doctors. TENS is the most basic definition of electrical nerve stimulation with the help of

the skin tract. This method has been applied to thousands of patients and has been used as a

reliable method. TENS administration stimulates nerves that produce pain relief in the

brain and spinal cord. As a result, natural substances secreted by the body are used for pain

treatment.

33

Thus, the drug use of the patients is reduced and the patients are protected from the side

effects of the drugs. This is one of the main purposes of designing specifically for

acupuncture points. In addition, with the help of variable options that we have added to the

project, different treatment options are offered for each patient.

34

CHAPTER 5

CONCLUSION

5.1 Conclusion

TENS (Transcutaneous Electrical Nerve Stimulation) is the most useful and effective

application of electrotherapy with various forms of electric current used. TENS is the most

basic definition of electrical nerve stimulation with the help of the skin tract.

This method has been applied to thousands of patients and is used as a reliable method.

The TENS application stimulates the nerves that produce the painkillers in the brain and

spinal cord. As a result, natural substances secreted by the body itself are used for pain

treatment. Thus, the drug use of the patients is reduced and the patients are protected from

the side effects of the drugs.The handy features of the TENS therapy are practical, side-

effect, battery-powered, small devices. Of course, this therapy should be done with a

doctor's recommendation. Patients should apply their doctor's recommendations and

treatment plans prescribed by the doctors.Acupuncture is a scientific treatment method. It

is a method applied by sinking the needle in certain points in the body. According to

acupuncture, there is a network of energy that completely surrounds the body surface. And

there are central points that can reduce, increase, direct or even direct this energy to a

certain point.

In this project, firstly physical therapy methods that can be applied with the aid of electric

current and the effects of these treatments on the patient's body are examined; TENS

devices which are frequently used in electrotherapy are emphasized. The main goal of the

project is to stimulate the acupuncture points.For practical part of the project, TENs device

was designed to be applied to acupuncture points. Features that are different from similar

ones in the designed device; easy-to-use, low-cost, varied options, integrations and

succession for appropriate treatment programs. Device; frequency, current power, impulse

width as a set of three options are available.

35

REFERENCES

Allen, R. J. (2006). Physical agents used in the management of chronic pain by

physicaltherapists. Physical medicine and rehabilitation clinics of North

America, 17(2), 315-345.

Cabioğlu, M. T., & Cetin, B. E. (2008). Acupuncture and immunomodulation. The

American journal of Chinese medicine, 36(01), 25-36.

Cheing, G. L., & Chan, W. W. (2009). Influence of choice of electrical stimulation site

on peripheral neurophysiological and hypoalgesic effects. Journal of

rehabilitation medicine, 41(6), 412-417.

GÖKSOY, T. (2010). Akupunkturun Tarihçesi. Turkiye Klinikleri Journal of Physical

Medicine Rehabilitation Special Topics, 3(1), 1-5.

Haley, S. M., & Fragala-Pinkham, M. A. (2006). Interpreting change scores of tests

and measures used in physical therapy. Physical therapy, 86(5), 735-743.

Itoh K, Itoh S, Katsumi Y, Kitakoji H. A pilot study on using acupuncture and

transcutaneous electrical nerve stimulation to treat chronic non-specific low back

pain. Complement Ther Clin Pract. 2009;15(1):22–5

Johnson, M. (2007). Transcutaneous electrical nerve stimulation: mechanisms, clinical

application and evidence. Reviews in pain, 1(1), 7-11.

Johnson, M. I. (2007). Transcutaneous electrical nerve stimulation (TENS). eLS.

Johnson, M. I. (2007). Transcutaneous electrical nerve stimulation (TENS). eLS.

Kahn, J. (2000). Principles and practice of electrotherapy. Saunders.

Kalyon, T. A. (2007). Akupunktur Tedavisi. Turkish Journal of Physical Medicine &

Rehabilitation/Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi, 53.

Maayah, M., & Al-Jarrah, M. (2010). Evaluation of transcutaneous electrical nerve

stimulation as a treatment of neck pain due to musculoskeletal disorders. Journal

of clinical medicine research, 2(3), 127.

36

Moffet, H. H. (2006). How might acupuncture work? A systematic review of

physiologic rationales from clinical trials. BMC complementary and alternative

medicine, 6(1), 25.

Özdemir G., Ahmad A., Telatar Z., Eroğul O.(2015). Mıcrocontroller Based Tens

Devıce Desıgn

Perez Machado, A. F., Santana, E. F., Tacani, P. M., & Liebano, R. E. (2012). The

effects of transcutaneous electrical nerve stimulation on tissue repair: A literature

review. Canadian Journal of Plastic Surgery, 20(4), 237-240.

Pope GD, Mockett SP, Wright JP. A survey of electrotherapeutic modalities:

Ownership and use in the NHS in England. Physiotherapy Theory and

Practice. 1995;81(2):82–91

Robertson, V. J., Low, J., Ward, A., & Reed, A. (2006). Electrotherapy explained:

principles and practice. Elsevier Health Sciences.

Santana, L. S., Gallo, R. B. S., Ferreira, C. H. J., Duarte, G., Quintana, S. M., &

Marcolin, A. C. (2016). Transcutaneous electrical nerve stimulation (TENS)

reduces pain and postpones the need for pharmacological analgesia during

labour: a randomised trial. Journal of physiotherapy, 62(1), 29-34.

Sluka, K. A., & Walsh, D. (2003). Transcutaneous electrical nerve stimulation: basic

science mechanisms and clinical effectiveness. The Journal of pain, 4(3), 109-

121.

Vas, J., Perea-Milla, E., & Méndez, C. (2004). Acupuncture and moxibustion as an

adjunctive treatment for osteoarthritis of the knee-a large case

series. Acupuncture in Medicine, 22(1), 23-23.

Vickers, A., & Zollman, C. (1999). ABC of complementary medicine:

acupuncture. BMJ: British Medical Journal, 319(7215), 973.

37

Retrieved May 30, 2018 from http://www.biyoklinikder.org/TIPTEKNO15_Bildiriler/

108.pdf

Retrieved May 30, 2018 from http://docs.neu.edu.tr/library/6507379945.pdf

Retrieved May 30, 2018 from http://diyot.net/potansiyometre

Retrieved May 30, 2018 from http://simpleposture.org/at-last-get-rid-of-lower-back-

pain-with-electrotherapy-treatment-once-and-for-all/

Retrieved May 30, 2018 from http://slideplayer.com/slide/8629776/

Retrieved May 30, 2018 from http://www.akupunkturterapi.com/haber/34/

akupunkturun-etki-mekanizmasi

Retrieved May 30, 2018 from http://www.capacitorworld.net

Retrieved May 30, 2018 from http://www.drdenizdogan.com/p/

fizik-tedavi-ajanlar.html

Retrieved May 30, 2018 from http://www.electrotherapy.org/modality/transcutaneous-

electrical-nerve-stimulation-tens

Retrieved May 30, 2018 from http://www.elsa.web.tr/tr/haber/agri-tedavisinde-tensin-

yeri-nedir

Retrieved May 30, 2018 from http://www.sevilakova.com/services/

electro-acupuncture-2/

Retrieved May 30, 2018 from http://www.tensproducts.com/

TENS-electrodeplacement_ep_49.html S

Retrieved May 30, 2018 from http://www.toprakhatti.com

Retrieved May 30, 2018 from https://tr.123rf.com/photo_56909650_reflex-zones-on-

the-ear.-acupuncture-points-on-the-ear.-map-of-acupuncture-points-(reflex-

zones)-on-.html

38

Retrieved May 30, 2018 from https://www.arduino.cc/en/Main/

ArduinoBoardDiecimila

Retrieved May 30, 2018 from https://www.electronics-tutorials.ws/transformer/

transformer-basics.html

Retrieved May 30, 2018 from https://www.everydayhealth.com/ulcerative-colitis/

treatment/can-acupuncture-help-treat-ulcerative-colitis/